Descriptive study of genital variation in healthy, nonabused premenarchal girls

This descriptive colposcopic study of the genitals of symptom-free young girls not thought to have been sexually abused was undertaken to contribute toward our understanding of normal female genital anatomy in this age group. Girls were examined and photographed, with labial traction in a supine frog-leg position while they were under anesthesia before minor elective surgery. The final study sample consisted of 79 premenarchal girls, aged between 3 months and 11 years 7 months (mean, 5 years 4 months). The study demonstrated wide anatomic variation and a high frequency of minor irregularities that have previously been noted in studies of sexually abused girls. Specific findings included increased vascularity (44%), midline avascular areas (27%), "ragged" posterior fourchette epithelium (18%), notch configuration of the posterior fourchette (10%), delicate tethers between the hymen and perihymen (14%), hymenal bumps between the 3 and 9 o'clock positions (11%), and asymmetry of the hymenal tissue (9%). Girls who at initial examination had apparently abnormal vestibules had either large hymenal orifices (11%) or multiple irregularities (11%). The study emphasizes the danger of overinterpreting small anatomic findings when one is evaluating the possibility of sexual abuse in girls; such findings may lie within the range of normal variation.